Comparing long-term placements

for young children in care:

The Care Pathways and Outcomes

Study –

Northern Ireland

Book launch

11 September 2013

Council Chambers, QUB

Care Pathways and Outcomes Study

• Research team: Dominic McSherry, Montserrat Fargas Malet, Kerrylee Weatherall,

and Greg Kelly

• What is it about? Longitudinal study that examines placement patterns for a

population of children (n=374) under 5 years old and in care in Northern Ireland on

the 31st March 2000. It explores how the children & their parents/carers get on

within different types of placement – Key question, does care placement matter?

• Location: Institute of Child Care Research, School of Sociology, Social Policy and

Social Work, Queen's University, Belfast

• Funded by: The HSC Development Division of the Public Health Agency

• Book publisher: British Association for Adoption and Fostering (BAAF)

History of the Study – Phases 1 & 2

PHASE 1 - Care Pathways and Outcomes: Multiple Placements (2000-2003)

- Developed a placement history for the study population to 31st March 2002, and

established baseline characteristics for the study population prior to 31st March 2000

- MAIN FINDINGS: Multiple placement not common in Northern Ireland; but unexpectedly

high percentage of the study population had been adopted by 2002 (18%)

PHASE 2 – Care Pathways and Outcomes: The Carers’ Perspective (2003-2006)

- Further developed the placement profile for the study population from 2002 – 2004, and

involved interviews with parents/carers in adoption, foster care, and at home

- Adopted children were doing marginally better than children in foster care, and both these

groups were doing significantly better than those children returned to birth parents, with

the high levels of parental stress in the birth parents group being particularly concerning

Phase 3

Care Pathways and Outcomes: The Children’s Perspective (2006-2010)

• Developed a placement profile for the study population from 2004 to

2007

• Interviewed sub-groups of children and their parents/carers

• Profile of children interviewed:Adopted Foster Care Kinship

CareResidence Order

Birth Parents

Av. age enter placement

1yr 8 mts 4 yrs 3 yrs 5 mts 1 yr 5 mts 4 yrs 6 mts

Av. time in placement

10yrs 1mt 8yrs 5mts 8yrs 11 mts 10yrs 3 mts 8 yrs 3 mts

Quantitative Data - Children

• Piers-Harris Children’s Self-Concept Scale (Piers & Hertzberg, 2002)

- Examined children’s self-concept across 6 dimensions

- Applied using post-box activity developed by the research team

• Inventory of Parent and Peer Attachment - Revised Version (Gullone & Robinson, 2005)

- Examined parent and peer attachment across 3 dimensions

- Applied using poster activity developed by the research team

• The British Picture Vocabulary Scale – Second Edition (Dunn et al., 1997)

- Examined children’s verbal ability and verbal intelligence

- Proxy measure of scholastic aptitude

Physical appearance and attributes

Intellectual and school status

Happiness and satisfaction

Freedom from anxiety

Behavioural adjustment

Popularity

Trust

Communication

Alienation

Quantitative Data – Parents/Carers

• Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997)

- Commonly used behavioural screening questionnaire for assessing psychological

morbidity in children and adolescents, as perceived by their parents/carers

- Comprised of 25 items divided into 5 sub-scales, which in combination provide a

‘Total Difficulties’ score

• Parenting Stress Index – Short Form (PSI-SF) (Abidin, 1990)

- Measures stress in the parent-child relationship

- Composed of 36 items divided into 4 sub-scales. A combination of scores across

the sub-scales provides a ‘Total Stress’ score

Emotional symptoms

Conduct problems

Hyperactivity / inattention

Peer relationship problems

Pro-social behaviour

Defensive responding

Parental distress

Parent-Child Dysfunctional interaction

Difficult child

Qualitative Data - Children

• A standard face-to-face interview with a stranger might be uncomfortable for the

child.

• A storybook was developed, the ‘Me-Book’, that acted as a catalyst for the semi-

structured interview - Downloadable from: http://www.qub.ac.uk/cpo

• Each page referred to a topic, and involved activities (e.g. writing, drawing, using

stickers, circling pictures), covering a range of key issues deemed important for

understanding the children’s lives

• Children who piloted the ‘Me-Book’ described it as providing a ‘protective cover’,

where they didn't feel they were being analysed, and could express themselves

more freely.

Family membership

Degree of closeness to family members & friends

People important to child’s life

Family activities

School life

Interests / hobbies

Health and happiness

Feelings about the past / present/ future

Future aspirations (employment / accommodation)

Qualitative Data – Parents/Carers

• Semi-structured interview with parents that covered 12 key areas:

How the placement was progressing

The child’s attachment to them, and the bonding with child

The child’s behaviour

Contact with birth family or previous carers

Supports

Involvement with social services

Family activities

School and child’s peer relationships

The child’s health

Communication with the child

Feelings and expectations regarding child’s future

Findings

• Placement profile 2000 – 2007

• Care pathway and regional variations

• Placement stability

• Attachment

• Self-esteem and happiness

• Behaviour

• Education

• Parental/carer stress

• Contact with birth family

• Social service involvement and social support

Placement Profile 2000 - 2007

2000 2002 2004 20070

10

20

30

40

50

60

70

AdoptedBirth parentsFoster careKinship careResidence OrderProspective Adoption

Care Pathway Regional Variations 2007

NorthernSouthern

South EasternWestern

BelfastTotal Population

63

69

39

25

32

45

18

15

36

14

23

209

6

15

43

23

207

2 5

14

11

9

38

54

10

6

AdoptionBirth ParentFoster careKinship careResidence Order

Placement Stability

Adoption Foster care Kinship care Residence order

Birth parents

99

87

9695 95

Placement stability achieved

Children’s attachments to their parents/carers

IPPA-R results

Adoption Foster care Kinship care Residence order

Birth parents

HighMediumLow

Children’s self-esteem and happiness

Piers-Harris self-concept scale

Adoption Foster care Kinship care Residence order

Birth parents

High

Average

Low

Children’s health and behaviour

• Who had behavioural difficulties according to SDQ?

Adoption

Foster care

Kinship care

Residence Order

Birth parents

Gen. Pop.

28

44

25

14

50

10

% clinically high difficulties

Children’s health and behaviour (contd.)

• Which children had serious health problems according to parents/carers:

- 1/11 in kinship care (9%)

- 5/15 in foster care (33%)

- 6/15 on Residence Order (40%)

- 5/12 with birth parents (42%)

- 11/18 Adopted (61%)

• Children had a range of conditions, BUT these most prevalent in the adoption

group, e.g. 8 diagnoses of FAS in total (n=77), with 5 of these in the adopted group.

• The majority believed that child’s behaviour had stayed the same or improved.

• Many parents/carers highlighted the strengths of children and positive behaviours.

Children’s education

• The majority of children had poor scores in the BPVS

• The majority of children adopted by previous foster carers and nearly half of those

in foster care were receiving some additional supports at school. Most children

living with birth parents were not receiving supports, despite needing it most.

• The majority of parents/carers believed children were coping very well/ “alright” at

school (considering their limitations), a few identified problems (e.g. bullying and

behavioural problems).

• A few children appeared to do very well at school and had passed the Eleven Plus

test – but low expectations from teachers and social services.

39

50 50

36

78

25

% low scores

Parent/carer stress

PSI/SF results

Adoption (n=18)

Foster c

are (n=16)

Kinship ca

re (n=12)

Residence

order (

n=14)

Birth parents

(n=12)

Gen. Pop.

22

44

33

21

50

15

% clinically high stress

Contact with birth families

• Majority had some sort of contact

• Regular face-to-face contact with parents/siblings common for foster, kinship and

RO children but adopted children – post-box contact.

• Contact arrangements changed over time, reducing or stopping altogether

• Many children, especially in foster or kinship care, used to have negative reactions

to contact in the past, but for the majority, the situation had improved.

• Some children were happy with the level of contact, others longed for more

contact with birth family or even wished to live with them.

• The majority of parents/carers whose children had face-to-face contact had no

issues, but where tensions existed - in kinship care.

Social Services’ Involvement

• Birth parents were the most critical of the support provided by social services

(feeling marginalised, undermined and distrusted by social services).

• Some adoptive parents advocated for a continued role of social services; while

others in addition to some RO carers felt a sense of ‘abandonment’ by social

services post-adoption/post-Residence Order.

• A few kinship carers experienced a sense of disregard and lack of support, and felt

less valued/supported by social services precisely because they were relatives.

• Some Residence Order carers were happy that social services were no longer

there, leading ‘normal’ family lives; others advocated a continued role for social

services, in terms of the provision of financial support.

• Most kinship carers were happy with the support being provided by social

services.

Social support

• The most important source of support provided for the parents and carers

was their family.

• Birth parents had the least extensive network of support, in relation to

both family and friends.

• Foster carers and Residence Order carers had access to the most extensive

family support networks. Their extended family were closely involved in

the lives of their children.

• Support from extended family also provided on an extensive basis for the

majority of adoptive parents who also fostered the child.

Summary

• Placements characterised by stability, not much evidence of instability, BUT mostly

entering teenage years – What happens next is critical

• All long-term placements have the potential to nurture positive outcomes for

children in terms of their attachment to parents/carers and self-concept

• Highlights the importance of speaking to children

- Children perspective, most securely attached and happy

- Parental/carer perspective, higher level of problem behaviours and clinical stress

for foster carers and birth parents

• Significant health problems most prevalent in adoption

• In educational terms, those with greatest need, i.e. children living with birth

parents, received least amount of support

Thank you!

Book launch

11 September 2013

Council Chambers, QUB